Orders to hold meds?

I've been reading and noticed nurses writing that they would call a dr and ask if they can hold a med due to low bp or low hr, and write that as an order, and then get parameters for future med administration.

Is this something that we have to do for risk of losing our license or administrative action, etc? When we pass meds, there is an option where you can select that the med was not given, then a drop down menu: patient off floor, patient npo, patient nauseous, bradycardia, hypotension, patient somnolent, etc. etc. I've typically just chosen one of those options if I held a med. Should I be calling the on-call PA/NP (I work nights) and informing them? I can't recall whether or not I was told that in orientation, so I'm just curious.

I would call to let them know because they may have tests going on next day that could be affected by holding the med. as long as the orders state to hold med insert parameters then your license is okay but anytime treatment is altered it should be reported in my opinion. I know I had a PA once who wrote orders for NPO and my patient was only on po meds, she was very upset that the BP meds had not been given all day and no one had told her I had to remind her that if she wanted meds the order should've been NPO except meds. She even went to my supervisor and luckily my supervisor backed me up. Just a miscommunication but what I took from that was always to report to provider

Jan 29, '13

I always notify the doctor if I hold a med that doesn't have parameters on the order, but I would not wake up a doctor for that. I work days, and often night shift lets me know if they held anything, and I will let the doctor know (and also ask for parameters if there aren't any).

Jan 29, '13

It depends what the med is. If you hold Colace because the patient refuses? No. If you can't wake the patient up to get them to take their anti-seizure medicine? Yes and request order for IV coverage.

Feb 1, '13

To me it also depends on what the pt is in there for. I had a pt that was in the hospital for SOB, she was stable respiratory wise, but there were some other issues. She started refusing her IV solumedrol, definitely something to call the physician on.

Feb 1, '13

I have never gotten in trouble for holding a med, typically a BP med when the bp was questionable. We are given some autonomy in med administration where I work. A doctor would simply be like "... Why are you calling me at 2130 to tell me you hold a toprol?" I would feel better if parameters existed. Many times I discuss meds with the patient and ask what they would do at home, especially related to diabetics and insulin coverage. We may give partial doses and mds are okay with it (within reason).

Refer to policy or your charge nurse. When in doubt, call.

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